The present disclosure relates generally to feeding tubes surgically implanted in patients who cannot receive their daily nutritional intake orally. More particularly, the disclosure relates to feeding tubes and techniques for their initial placement and subsequent location within the patient wherein ultrasound imaging is used.
When a patient is unable to swallow or cannot ingest food orally, enteral feeding is used to provide nutrition through a feeding tube that is inserted into the patient's digestive tract. Placement of the feeding tube in the patient's digestive tract may be temporary for the treatment of acute disabilities or permanent in the case of chronic disabilities. Percutaneous access for enteral nutrition may benefit placement of feeding tubes and allow patients to have a more active lifestyle and a more “normal” life. Presently, feeding tubes are designed for the delivery of enteral nutrition and/or medication into the stomach or the small bowel or intestine.
Several percutaneous gastrostomy methods are currently used which gain access to the stomach by a needle or cannula forced into the stomach. A percutaneous endoscopic gastrostomy (“PEG”) is commonly performed by the “pull” technique, the “push” technique, or the introducer technique. There are many variations to the “pull” technique, the “push” technique, or the introducer technique as are commonly known. However, as described later, complications can occur which require the position of the implanted gastrostomy tube to be verified within the patient. Presently, either fluoroscopy or endoscopy is used to determine the position of the gastrostomy tube. Fluoroscopy exposes the patient to radiation emitted by the imaging system.
PEG tubes positioned in the body are typically held in place by both internal and external devices. For example, PEG tubes may have an internal retention mechanism such that the end of the PEG tube is held in place within the stomach or the intestine. This internal retention mechanism may take the form of a disk, dome, bowl, multiple flanges or leaves, a soft dome, or an inflatable balloon that is attached to the distal end of the feeding tube. The external retention mechanism is often affixed (e.g., adhesives, sutures) to the patient's skin or a mechanical device, such as a ring, is attached to the PEG tube exteriorly of the patient's skin but adjacent or next to the skin. Together these internal and external devices function to secure the PEG tube from inadvertent removal. Nonetheless, PEG tubes are often inadvertently dislodged or removed by patients or care-givers through excessive traction placed on connectors or tubing lines. When potential dislodgment of a PEG tube is suspected, the patient must undergo endoscopy or fluoroscopy to determine the position of the PEG tube. As described later, endoscopy and fluoroscopy can be accompanied with substantial risks to the patient.
Moreover, as the elderly population continues to grow, it is expected the use of PEG tubes will continue to rise. Some patients undergoing PEG tube placement are subject to complications associated with upper endoscopy and sedation. The most common complications of endoscopy include perforation of the stomach, small intestine, or colon, hemorrhage, and aspiration. Perforation of the body part can be verified using fluoroscopic imaging of the PEG tube in the patient. The use of fluoroscopic imaging exposes the patient to harmful radiation and requires the use of a radiology laboratory which is expensive.
Another complication that can arise with PEG tube placement is leakage of the tube feeding formula and/or gastric contents around the PEG site. One risk factor that can contribute to such a complication includes buried bumper (internal retention mechanism) syndrome. Buried bumper syndrome refers to the condition in which there is a partial or complete growth of gastric mucosa over the internal bumper or internal retention mechanism. The internal retention mechanism can migrate through the gastric wall and may lodge anywhere along the PEG tract. The buried bumper may be confirmed endoscopically or radiographically, again, exposing the patient to the risks associated with endoscopy and harmful radiation. Moreover endoscopy is performed in a hospital operating room or outpatient facility which are expensive.
Thus, there is a need for improvement in this field.